Should endometrial biopsy under direct hysteroscopic visualization using the grasp technique become the new gold standard for the preoperative evaluation of the patient with endometrial cancer?

Attilio Di Spiezio Sardo, Maria Chiara De Angelis, Luigi Della Corte, Jose Carugno, Brunella Zizolfi, Elia Guadagno, Annarita Gencarelli, Elena Cecchi, Tommaso Simoncini, Giuseppe Bifulco, Fulvio Zullo, Luigi Insabato

Research output: Contribution to journalArticle

Abstract

Objective: To investigate the diagnostic accuracy of endometrial biopsy performed with hysteroscopic direct visualization using the “grasp technique” for the detection of endometrial carcinoma (EC) histology type and tumor grade. Methods: A cross-sectional study including the clinical and pathology records of patients with confirmed EC who underwent definitive surgery at University of Naples was performed. The preoperative diagnosis of endometrial tumor type and grade obtained using the hysteroscopy grasp technique was correlated with the final pathology specimens. Those results were compared to the diagnostic accuracy of the biopsies collected in a cohort of patients who underwent preoperative diagnostic hysteroscopy followed by blind endometrial biopsy using the Novak curette with subsequent surgical definitive treatment at University of Pisa. Statistical analysis was based on frequency data and diagnostic agreement of the pathology results. Results: A total of 129 patients were included in the final analysis. An agreement rate of 104/106 (98.1%) for endometrioid type and 15/23 (65.2%) for non-endometrioid type was obtained between preoperative hysteroscopic grasp endometrial biopsy specimens and the final pathology with a coefficient k for G1, G2 and G3 tumors of 0.928, 0.925 and 0.974, respectively. When compared to 121 patients undergoing preoperative blind Novak endometrial biopsy, the hysteroscopic grasp technique was superior in agreement rates for tumor histotype [diagnostic accuracy (0.922 vs 0.890); K value (0.705 vs 0.642)] and grade when in presence of endometrioid type EC (K Cohen 0.354 for G1, 0.263 for G2 and 0.488 for G3). Conclusions: Preoperative hysteroscopic guided “grasp” endometrial biopsy provides a more accurate diagnosis of EC histology type and tumor grade when in presence of endometrioid type tumor compared to blind endometrial biopsy obtained using the Novak curette.

Original languageEnglish (US)
Pages (from-to)347-353
Number of pages7
JournalGynecologic oncology
Volume158
Issue number2
DOIs
StatePublished - Aug 2020

Keywords

  • Endometrial cancer
  • Grading
  • Outpatient hysteroscopy
  • grasp technique

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Fingerprint Dive into the research topics of 'Should endometrial biopsy under direct hysteroscopic visualization using the grasp technique become the new gold standard for the preoperative evaluation of the patient with endometrial cancer?'. Together they form a unique fingerprint.

  • Cite this

    Di Spiezio Sardo, A., De Angelis, M. C., Della Corte, L., Carugno, J., Zizolfi, B., Guadagno, E., Gencarelli, A., Cecchi, E., Simoncini, T., Bifulco, G., Zullo, F., & Insabato, L. (2020). Should endometrial biopsy under direct hysteroscopic visualization using the grasp technique become the new gold standard for the preoperative evaluation of the patient with endometrial cancer? Gynecologic oncology, 158(2), 347-353. https://doi.org/10.1016/j.ygyno.2020.05.012